– Victory on Medical Loss Ratios. The Executive Committee of the NAIC approved the medical loss ratio recommendation made by the subcommittee on this issue. In spite of receiving a lot of pressure from insurers, brokers and other industries, the Commissioners stayed the course and remained respectful of NAIC process by voting yes on the recommendation, with very few changes.  Thanks to the consumer representatives on the NAIC, who have worked for months to ensure the MLR definition is based on actual medical costs and evidence-based quality improvement efforts. And, thanks to advocates to who called their Insurance Commissioners about this issue. This is good news – and we expect HHS to accept the NAIC’s recommendation.  What this means for advocates: This is a procedural win that is gets us closer to a tool to fight unwarranted premium increases and get consumers better value for their insurance dollars. It also demonstrates that we need to monitor these decisions and make our voices heard as necessary to ensure consumers are protected.

– Brokers feel the love. In a bizarre turn of events, the NAIC spent their summer weekend drafting an “ode to brokers.” The resolution, sponsored by a number of Insurance Commissioners, expressed support for the work that brokers do for the insurance market.  A clause in this resolution suggests that brokers should be favored as Navigators, the entities that will help to explain and enroll people in coverage and plans through the Exchange starting in 2014. This is inconsistent with the intent of the ACA, which clearly lists potential Navigators as “trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused non-profit groups, chambers of commerce, unions, small business development centers, other licensed insurance agents and brokers, and other entities.” (Section 1311(i)). It is unclear what weight this NAIC resolution holds.  But one thing is certain: brokers were flexing their muscles in Seattle, and many Commissioners were impressed. What this means for advocates: We need to educate Insurance Commissioners and others in state government about the importance of community-based groups in providing public education, health plan information, and enrollment assistance, other critical roles of Navigators.

– Everyone’s thinking about Exchanges. NAIC created a tentative workplan for the subgroup charged with working on Exchanges. They are dividing into 14 smaller workgroups (leads should be posted on the NAIC website soon).  But we hear that one of the subgroups will work on a “skeleton” model law for states, which will basically track the statutory requirements and no more. Other subgroups are likely to respond to HHS’s request for recommendations on (1) network adequacy, (2) marketing standards and (3) quality measures.  Another group will tackle “principles and priorities” on a number of other big exchange topics such as governance and operations. (TBD). Another high-level liaison group will work with state Medicaid heads on plans for collaboration. What this means for advocates: The NAIC may have helpful resources as states begin to design Exchanges.  More to come.

– Lastly, though not specific to NAIC, rate review grant announcements were also made last week. A number of Insurance Commissioners talked about using the funds to increase consumer involvement in the process and get more information out to public. What this means for advocates: If your state applied for and received a grant to increase rate review, now is the time to work with your Commissioner on a plan to increase consumer involvement in the premium oversight process.

– Christine Barber, Senior Policy Analyst

A short-sighted proposal from U.S. Senator Mike Johanns, a Nebraska Republican, would gut the brand-new $15 billion Prevention and Public Health Fund, created as part of the health reform law, to pay for a change in business tax-reporting rules. The Prevention Fund was established to support national, state and local programs to make Americans healthier and reduce racial and ethnic health disparities. President Obama has already allocated $500 million from the fund.

Johanns’ amendment is slated for a vote on Sept. 14, the day after Congress returns from August recess, and has some strong business backing. Learn more about this strike at a key component of health reform on a 1 p.m. call tomorrow hosted by Community Catalyst and three partner organizations.

The Prevention Fund is key to our long-term health, to controlling soaring health costs, and to advancing health equity. Among the programs Johanns’ proposed amendment would wipe out are the innovative Community Transformation Grants. These grants are designed to help local communities address health disparities and reduce chronic diseases by promoting healthy living and tackling the social and economic causes of poor health. They are also the main avenue in the health reform law for addressing the root causes of health disparities, such as poor availability of healthy food and exposure to environmental hazards.

The Johanns amendment could also threaten initiatives to increase vaccination against disease, as well as millions of dollars a year in state grants to reduce obesity and tackle other public health problems. Congress envisioned all of these being supported by the Prevention Fund, which dedicates $15 billion over 10 years to beef up the tiny portion of health spending now devoted to preventing illness.

Johanns proposed the amendment to a bill (H.R. 5292, the Small Business Jobs and Credit Act) that would create a loan fund and tax breaks for small businesses.  His amendment would overturn a portion of the health reform law that requires business to provide more detailed reporting to the Internal Revenue Service about services and materials they buy. Small businesses, in particular, are concerned that the new reporting would be a burden, and passage of the amendment is a real possibility.

To offset the loss of tax revenue created by his proposal, Johanns would tap $11 billion from the Prevention Fund – all of the money allocated for the fund from 2010 through 2017. He would also weaken another critical component of health reform – the requirement that everyone who can afford health insurance must obtain it, or pay a penalty. Our partners at the Center on Budget and Policy Priorities have written a detailed analysis of the proposal.

Community Catalyst is signing onto a letter to Congress opposing the gutting of the Prevention Fund, and we urge other organizations to do the same. We also recommend contacting Senators directly to let them know that the Prevention Fund should not be up for grabs. Two small business organizations, Small Business Majority and Main Street Alliance, are also speaking out against the attack on the Prevention Fund, with Main Street saying it would “seriously undermine the improved access and cost containment goals of health reform.”

Ironically, Johanns’ attempt to wipe out the Prevention Fund comes just as Congress is considering separate measures to allocate hundreds of millions of dollars from the fund to the Community Transformation Grants for fiscal year 2011. Rules for the competitive grant program are still being developed, but the health reform law says the grants should go to state and local governments and community-based organizations for changes in policies, programs, environment and infrastructure including increasing access to nutritious foods, creating parks, and creating healthier school environments.

Senator Bill Nelson, a Florida Democrat, is offering an alternative that helps small businesses without harming the Prevention Fund. It scales back, rather than eliminates, the new tax reporting requirement, and funds the change by ending a tax break for the nation’s five large oil companies.  Nelson’s amendment is also slated for a vote on Sept. 14. Both this and Johanns’ amendment need 60 votes to pass, and the votes could be close.

It’s crucial to the success of health reform to beat back the Johanns amendment and send a message to others who would try to hijack the Prevention Fund for other purposes.

– Alice Dembner, policy manager

How serious are these multi-million dollar sweetheart deals that prevent consumer and health system savings? The Federal Trade Commission, the federal government’s consumer protection watchdog, reported in January that these agreements delay the entry of generic drugs into the market by an average of 17 months. Given that generic entry can reduce the price of branded drugs by up to 90 percent, the FTC estimates conservatively that the cost of these delays is at least $3.5 billion in lost savings per year.

Through these pay for delay deals, the brand-named drug manufacturer gets to continue to be the exclusive seller of the drug and the generic manufacturer makes money for not bringing a generic (non-patented) version of the drug to market. It is then left to consumers and the government to pay the price for the high drug costs that result from these agreements.

21 new pay-for-delay deals in 2010 may cost consumers and the health care system $9 billion

The FTC warned in recent Congressional testimony that pay-for-delay agreements are becoming more common and have reached the point of being “almost an epidemic” (see graph). Deals rose from only three in 2005 to 19 last year and 21 in the first nine months of 2010. This dramatic increase followed court decisions since 2005 by a few appellate courts that, according to FTC, “misapplied the antitrust law” to uphold these agreements as not anticompetitive.

Federal Trade Commission

The FTC’s preliminary analysis of the 21 agreements filed this fiscal year concludes that they cost $9 billion in lost savings. Past pay-for-delay agreements to date are estimated by FTC to cost all public and private purchasers at least $20 billion — an estimate that may rise given the current spike in agreements. FTC estimates that these settlements cost consumers and our health system at least $3.5 billion a year, while other experts suggest that the potential total savings could be closer to $12 billion a year if pay-for-delay settlements were ended.

The federal government — and health reform sustainability — would benefit greatly from banning these agreements. The Congressional Budget Office estimated the savings to the federal government alone of around $2.6 billion over the next ten years.

Legislative History

A bill to ban these agreements was included in the House’s health care reform proposal last fall. Unfortunately, though a similar measure was supported by the White House and considered by the Senate, the procedural and jurisdictional rules in the Senate kept the measure from being included in the national health reform bill enacted last March.

House leaders were undeterred by this set-back and added language banning these deals to an appropriations bill approved on July 1st. Unfortunately, the Senate went on to strike this provision from an appropriations bill they subsequently approved. But two weeks ago, the bill’s longtime advocate, Senator Herb Kohl (D-WI), along with Senator Richard Durbin, succeeded in including this provision as an amendment to the Senate’s Financial Services and General Government Appropriations Act.

On July 29th, an effort by pharma to strip this provision was narrowly defeated in the Senate Appropriations Committee. Senator Arlen Specter (D-PA) had introduced an amendment to strip the provision from the Committee bill, and when four other Democrats voted with Specter, the Associated Press reported that:

“Drug company lobbyists in the audience thought they had the vote won, provided they could win over every panel Republican. But Sen. Richard Shelby, R-Ala., voted against the drug companies, helping give Kohl and Durbin [the author of the Appropriations Bill] a surprise win.”

The successful Senate Committee vote signaled to FTC Chairman Leibowitz that “the tide may be turning,” and that “consumers are one step closer to saving billions on their prescription drugs.”   The bill’s Senate sponsor, Senator Kohl, pointed out why this decision can’t come soon enough:

“The cost of brand-named drugs rose nearly 10 percent last year. In contrast, the cost of generic drugs fell by nearly 10 percent. At this time of spiraling health care costs, we cannot turn a blind eye to these anticompetitive backroom deals that deny consumers access to affordable generic drugs.”

This recent vote is a crucial step. The potential savings to both consumers and the government is substantial and is particularly important in these turbulent financial times. A New York Times editorial this week emphasized that these potential savings “would reduce the federal deficit by $2.6 billion over the next decade, freeing up money for worthy programs that would otherwise be cut.”

Why should we allow these agreements to continue to the financial benefit of only a small subset of the U.S. population when the savings that would result from banning these agreements could benefit a far greater number of individuals? It is about time for the pay-for-delay settlement to meet its long-awaited demise.

The final vote in Congress on the Appropriations bill will likely come sometime after the election. It will take vigilance and aggressive action by supporters to combat PhRMA’s tactics again — just last week they released a new report disputing the FTC analysis. But in Pharmalot, an FTC representative states: “The pharmaceutical industry can fund as many studies as it wants, but it can’t change the facts — these pay-for-delay deals cost consumers $3.5 billion a year.”

– Emily Cutrell, legal intern
– Wells Wilkinson, Director of Prescription Access Litigation project

Prescription data mining, described in more detail here, is the business of health information organizations, such as IMS Health, Verispan and Wolters Kluwer. These companies purchase records from pharmacies containing prescription information (but not patient identities), combine them with practitioner profiles purchased from the American Medical Association and sell complete practitioner prescribing profiles to pharmaceutical companies. These profiles let marketers know exactly which drugs individual practitioners are prescribing so they can tailor their promotional messages to them. Maine’s law allows health care practitioners to “opt-out” of releasing their prescribing data for marketing purposes at each instance of licensure or re-licensure. The AMA has its own “opt-out” system, but few doctors even know about the program. Furthermore, it still allows drug companies to buy the disapproving physician’s prescribing profile, only requiring they refrain from sharing the individual-level prescribing data directly with the sales reps.

It’s clear that showing up in an office to pitch a new drug armed with the doctor’s complete prescribing history creates an unlevel playing field, making the interaction less about education and more about sales objectives. It’s not a surprise that most prescribers are not aware that their prescribing data is for sale. It’s even less surprising that drug reps are reluctant to inform prescribers that they have access to this information.

Solutions and Appeals

In 2006, New Hampshire passed the first-in-the-nation law completely banning the sale and use of prescriber-identifiable prescription data for marketing purposes. Representative Cindy Rosenwald—whom we’ve interviewed on related privacy issues before—pushed the legislation through the state assembly in 2006 as a measure to bolster public health and curb rising drug costs due to industry marketing.

Health information companies challenged the New Hampshire law shortly after it was enacted. A U.S. district court in New Hampshire overturned the law in April 2007 on the grounds that the use of such data by health information companies, pharmacies, and drug companies constitutes commercial speech; the law, they asserted, restricted that speech. New Hampshire Attorney General Kelly Ayotte appealed the decision and took the case to the United States Court of Appeals for the First Circuit. Community Catalyst and other consumer, professional and medical organizations presented arguments supporting the law in an amicus brief filed by, Sean Flynn of American University’s Washington College of Law

Strike One:

In late 2008, the First Circuit solidified the first in a series of major wins for prescription privacy advocates, upholding the New Hampshire law and affirming its constitutionality.  The Court found that the law regulates conduct rather than speech, so does not infringe on First Amendment rights. It ruled that the state can regulate this practice since it affects public health and costs of care. Last year, the Supreme Court refused to hear a further appeal of the New Hampshire law filed by the plaintiffs (IMS and Verispan).

In 2007, Vermont legislators had passed a similar law banning the use of prescriber-identifiable data, except in cases where a health care practitioner “opts-in,” agreeing to release their prescribing records to marketers.

Strike Two:

The Federal District Court in Vermont upheld the law on grounds that it would protect public health and contain drug costs, but the ruling was again appealed by health information organizations. Shortly after the Supreme Court refused to hear an appeal of the New Hampshire law, the Court of Appeals for the Second Circuit denied a request to grant an injunction of Vermont’s law, allowing the law to go into effect last July. We and others supported the law in an amicus brief. The Court is still considering the appeal and a decision is expected soon.

Where We Stand

For those keeping score, we now have three variations of data mining laws in three states. We’ve got the total ban, the “opt-in” and the “opt-out.” Each of the states has also been given the go-ahead to implement its law, though we’re still waiting for the outcome of the final appeal on the Vermont statute.

The First Circuit ruling is another win for prescription privacy and public health advocates. But the ruling may be most significant because there isn’t really anything remarkable about it. It feels like we’ve been here before, heard many of the same arguments and had similar results. Even though these three laws differ slightly in how they go about it, they all have the same intent: to limit drug reps’ access to prescriber-identifiable data. The legal and public health arguments for limiting data mining are clear, and that’s been shown time and again. Last week’s ruling in Maine cited many of the same findings from Vermont and New Hampshire decisions: the statute is constitutional, does not infringe on free speech guarantees, stands to protect public health and will save public dollars.

Maybe this was strike three. Or maybe the final appeals court ruling on Vermont’s law will be strike three. Sooner or later it will come and advocates can focus on developing programs and systems that use prescription information to improve patient care, rather than simply defending against its use for marketing practices that drive up costs. With the passage of the new health law, we need smart strategies like these to make the health care system more sustainable while improving quality.

– Ian Reynolds, program associate

The Senate voted on Thursday to provide additional federal assistance to state Medicaid programs (and additional support for teachers to avoid layoffs) and the House followed suit today, but the price was high. After several attempts to pass an FMAP extension on an emergency basis (meaning no tax increase or spending cut to offset the new spending) were blocked by a united Republican Senate caucus, the leadership decided to pay for the financial assistance to states by rolling back a temporary increase in food stamps (SNAP). The SNAP increase, part of the American Reinvestment and Recovery Acct (ARRA), was originally projected to phase out in 2014, however, the slow growth in food prices would have extended the increase until 2018. The FMAP legislation means that the increase will indeed end in 2014, creating a cliff that at that time will cause a drop in SNAP benefits.

Senate leaders (supported by the administration) faced with the specter of failure on the fiscal relief legislation and the resulting layoffs of teachers and other state workers plus the scaling back of Medicaid benefits, decided that avoiding the harm now was the lesser of two evils. With luck there will be a chance to restore the SNAP benefit before the cut actually goes into effect in 2014.

The really sorry thing is what the FMAP/ SNAP trade says about the balance of power in the US Senate today. As much as we decry the use of SNAP as one of the funding sources, it is a sad fact that a more progressive source would have been unable to clear the Senate. Unfortunately, things are only likely to get worse in the short run. Republicans, aided by conservative Democrats, will continue to block important legislation (such as FMAP, or an extension of unemployment benefits or the energy bill) and then benefit from it electorally because the problem isn’t solved and people vent their bad mood on the party in power (see example here). With the electoral winds at their back – projections are for gains in the House, Senate and governorships – what’s the incentive for Republicans to change? The prototype for this behavior was health reform under Clinton which the Republicans were able to sabotage and then ride to victory in 1994. Running the same play in 2010 is likely to create new obstacles to ACA implementation in 2011. With a more closely divided Senate ahead, we can expect more replays of the FMAP dynamic until at least 2013.

What does the MO vote really mean? Not much, but VA decision more troubling

While ACA opponents are trumpeting the passage of Proposition C in Missouri, there really isn’t much ‘there’. The voter turnout was heavily weighted to GOP voters, making it more of a straw poll of Republican sentiment than a true test of public opinion. For example, in the Senate primary race 578,582 voted in the Republican primary while only 316,107 or 35 percent of the total voted in the Democratic primary – not too different from the 70-30 split on Prop C.

Further complicating the interpretation of Proposition C was the confusing wording of the multi-part question which addressed the mandate, the right to pay for health services and the ability to make changes to the rules for liquidating certain insurance companies. As a result, Proposition C is a much less accurate barometer of public opinion than the polling which is showing that public support for the ACA is growing (albeit slowly), opposition is declining and the “intensity gap is almost inside the margin of error.” However, the Missouri vote is likely to encourage continued ACA nullification efforts, which got something of a bigger boost from the Virginia court decision last week.

Essentially, the judge hearing the case ruled that, notwithstanding the supremacy clause of the Constitution, a state can pass a law that conflicts with federal statute and then sue to enforce it. To be sure, this is just a procedural decision and a number of legal experts believe the judge has erred and that the case will ultimately be resolved in favor of the ACA, but reading the judge’s reasoning can’t give supporters of the ACA great comfort; nor does the possibility of sending a case all the way to the current Supreme Court.

Be careful what you wish for

If ACA saboteurs really got their way, what would it mean?  Two new reports shed light on that question. A new analysis from economist Jonathan Gruber estimates that implementing the ACA without the Individual Mandate would increase premiums by 27 percent while Medicare Trustees say that total repeal would shift the Medicare trust fund into a deficit a dozen years earlier than current predictions (2017 vs. 2029). But then again, if your goal is to destroy Medicare and you don’t care about expanding coverage, maybe that doesn’t matter.

Is Howard Dean right about the Individual Mandate?

Criticism of the Individual Mandate does not only come from the right. Howard Dean recently was quoted as saying not only that the mandate would be repealed but that it wasn’t necessary. As evidence he cites his own state’s experience with providing near-universal coverage to children without a mandate. Actually Vermont, while offering good coverage for kids, is not unique. The state ranks 14 in the country with respect to the rate of children’s coverage according to Kaiser State Health facts, but even the state that ranks best – Massachusetts – lacks a mandate on kids coverage. The Massachusetts mandate applies only to adults. Does this prove Dean right? Not really.

Hypothetically a similar coverage result could be achieved without the Individual Mandate if Congress could be persuaded to make insurance subsidies sufficiently robust and accept a large migration of moderate-income workers from private to public coverage. However, the outcome of the Congressional debate over the ACA, when there were 60 Democratic Senators and a large majority in the House does not auger well for a large increase in publicly financed health insurance subsidies in the near future. Gruber’s analysis shows that only about 7 million people would gain coverage at current ACA subsidy rates without the Individual Mandate, as opposed to 32 million with the mandate.

The other alternative to the Individual Mandate often mentioned – late enrollment penalties – could work from the insurance industry’s point of view. Late enrollment penalties would protect against adverse selection by charging higher premiums to people who did not obtain coverage when it was available. It’s the method used to guard against adverse selection in Medicare Part D, but it is more likely to create insurmountable barriers to coverage for low-wage workers than it is to produce something approaching universal coverage.

– Michael Miller, policy director

Recently, the federal government issued regulations further explaining how this provision will work. Here at the New England Alliance for Children’s Health, an initiative of Community Catalyst, we support these regulations because they clarify several important points that will benefit young adults and apply the law with their interests at heart:

-Young adults are eligible for coverage under their parents’ plan regardless of what state they live in and whether they are tax dependent, financially independent, or a student, employed, or married.
-Premiums or benefits cannot vary based on the age of a young adult who qualifies as a dependent.
-The provision applies to all health plans and only grandfathered health plans (those in existence prior to March 23, 2010) can exclude young adults with access to an employer-sponsored plan until 2014. After 2014, this exception no longer applies.
-Insurance companies must provide prominent notice to enrollees about the special enrollment period for dependents.
-States have the option to extend dependent coverage beyond age 26.

All of these clarifications and others included in the regulations will ensure that dependent children and their families can take full advantage of this important opportunity to secure the health coverage they need.

While we are enthusiastic about the regulations, we’ve also been working collaboratively with a group of our partners to offer some suggestions to the federal government on how to improve them in a few key areas:

-Clarify that stepchildren and adopted children are included in the definition of a dependent child.
-Further explain the situations where grandfathered plans can remove young adults who are eligible for employer-sponsored insurance to ensure that this does not unduly burden young adults.
-Require that prominent notice be clear and conspicuous—ideally in the form of a stand-alone document highlighting the availability of the new coverage option and how to enroll.

It’s our hope that the regulations will be revised soon to reflect these suggestions, but in the meantime you can find out more about the dependent coverage expansion here. This provision is one of the many examples of the very real opportunities that ACA provides to extend coverage to those who otherwise would go without.

– Patrick Tigue, Children’s Health Care Coordinator, New England Alliance for Children’s Health

-The grant criteria take steps to ensure that the selected programs are independent. In particular, we are happy to see that the guidelines clearly welcome states to contract with non-profit organizations to provide consumer assistance.

-CAPs must assist people with all types of coverage and provide assistance that is culturally appropriate. In addition, programs must collect data about any problems and questions, which we hope will provide real-time, on-the-ground information about what’s working and what’s not. Regular feedback to state and local policymakers can help improve health reform implementation.

-Each state is eligible for one grant award. Therefore, it is important that states know about this grant program, so consumers can get help, no matter their zip code.

We applaud the guidelines, and have created a summary with the Community Service Society to further explain the grant criteria. Check out the rest of Barber’s post here, or read the full grant guidelines. Applications are due September 10.

– Christine Lindberg, Communications Associate

According to the Centers for Disease Control and Prevention, about nine out of 10 adults find it hard to follow routine medical advice, mostly because they don’t understand what their care providers are saying. The complex instructions and jargon that doctors use make patients more likely to skip necessary medical tests or not take their medication as prescribed. This confusion leads to poorer health outcomes and increased health care costs currently estimated at $238 billion a year.

There is a common assumption that lack of health literacy is limited to racial and ethnic minority populations. While these populations are disproportionately affected by low health literacy, according to a report from the National Patient Safety Foundation, Low Health Literacy: Implications for National Health Policy, the majority of people with low health literacy skills are white. Older people, recent immigrants and those with chronic conditions are likely to have low health literacy, as well.

Of particular note from the WSJ article is the federal strategy around health literacy entitled the National Action Plan to Improve Health Literacy. The plan seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked, multi-sector effort to improve health literacy

We are headed in the right direction. However, there is still a fundamental need for greater change in the health care system – particularly in the areas of how care is delivered and paid for – if we are truly to achieve better access to quality, affordable care.

As our population grows older and larger, the impact on the health outcomes of patients and the costs to the health care system will only increase. These problems are compounded by the lack of care coordination for those with multiple chronic illnesses. People with multiple chronic diseases have increased interaction with the health care system, leading to more opportunities for confusion surrounding their medical care – which is in turn influenced by the number of doctors they see and what they hear from their doctors.

An older person with five or more chronic conditions (e.g. diabetes, hypertension, heart disease, arthritis, obesity), has an average of 37 doctor visits, 14 different doctors, and 50 separate prescriptions each year. How incredibly confusing would it be for that person to manage his or her own health? Older adults and their caregivers should be full partners in their care, and they should be provided with the information and support to manage their conditions so they can make informed health care decisions.

With the advent of the Patient Protection and Affordable Care Act (PPACA), the Campaign for Better Care, led by the National Partnership for Women and Families, Community Catalyst and the National Health Law Program, is working to ensure the needs of older adults and their families are highlighted and addressed.

Helping patients and providers communicate effectively with each other will be a crucial component to the quality of care that patients receive. The Campaign’s national consumer coalition has developed a “Yardstick” for Better Care, which identifies key elements of patient-centered practice for inclusion in new models of care

The Campaign for Better Care hosted a public event today in Washington, D.C. – the “Building Better Care” forum – and the forum webcast will be available online Friday. Special guests included Senator Sheldon Whitehouse, award-winning author Gail Sheehy, UCLA Geriatrics Division Chief David Reuben, journalist and activist Jonathan Rauch, HHS Director of Delivery System Reform Peter Lee, and more.

To learn more about these issues and how the Campaign is tackling them please visit www.campaingforbettercare.org.

– Jenelle Holder Williams, Field Director, Integrated Care Advocacy Project

“While all states have adopted generic substitution laws, the extent to which pharmacists or patients can influence the medications they choose differs from state to state.  The Harvard researchers found that states that did not require patient consent to switch prescriptions from Zocor to the clinically equivalent, less costly simvastatin saved $15.35 per prescription on these medications in the first quarter after patent expiration.  If all states had adopted such policies, Medicaid programs could have saved $19.8 million nationwide on the introduction of simvastatin.

“While patients should be empowered to participate in their own health decisions, this study demonstrates that requiring patient consent for generic substitution impedes patients from initially choosing generics even when they will eventually prefer them to the brand name.”

Read the rest of the post on how generic prescriptions can save money with out sacrificing quality on PostScript.

– Joy Lee, policy intern

“With all of the controversy and rhetoric surrounding the requirement, it seemed a good time to take an objective, detailed look at how it will actually work.

“Plus, even though it doesn’t go into effect until 2014, we wanted to write about the individual responsibility requirement because it is the foundation on which much of health reform rests.  It allows the country to move forward with popular insurance reforms, such as the ban on excluding people from coverage if they are sick, and plays a major role in expanding coverage.”

Read the rest of the post that cites some of the themes that arose while working on the Q&A at “Say Ahhh! A Children’s Health Policy Blog,” or read the resource on our website.

– Katherine Howitt, policy analyst